Acute Setting Key Concepts Flashcards
Describe an intracapsular hip fracture
- Higher complication because of limited blood supply
- Repair with compression screw (or 2-3) if non-displaced
Describe the Garden classification stages for sub-capital fractures
- Predicts AVN
- Stage 1: non-displaced incomplete
- Stage 2: non-displaced complete
- Stage 3: complete but incompletely displaced (unstable)
- Stage 4: complete & completely displaced (unstable)
How is an intertrochanteric hip fracture repaired
- Repaired by THA
- Bipolar or unipolar
How is a subtrochanteric hip fracture repaired
- Repaired with compression screw + intramedullary rod gamma nail
- Compression screw & plate
Difference between a stable versus unstable pelvic fracture
- Stable: only one break in the pelvic ring (can mobilize)
- Unstable: 2 or more breaks in the ring or malalignment
What are the 9 do not want to miss serious pathologies
- Major depression
- Suicide risk
- Femoral head & neck fractures
- Cauda Equina Syndrome
- Cervical myelopathy
- AAA
- DVT
- PE
- Atypical MI
What is the normal range for Troponin
- <0.03 ng/mL
- Used as criterion standard for defining & diagnosing myocardial infarction (MI)
Describe normal and abnormal BNP labs values
- Normal: <100
- Cardiac disease: 100-300
- Mild sx and slight limitation during ordinary activity: >300
- Marked limitation in activity due to sx: >600
- Severe limitations & experience sx at rest: >900
What are the ranges for INR for normal and different diagnoses
- Normal: 0.8-1.2
- VTE/PE/A-fib: 2.0-3.0
- Stroke: 2.0-2.5
- Prosthetic heart valves: 2.5-3.5
- Lupus anticoagulant: 3.0-3.5
- Higher risk of bleeding: >3.6
What does D-Dimer test for
- Test for possible VTE
- Is a protein fragment produced when a blood clot gets dissolved into the body
- Typically undetectable or at really low levels unless when a blood clot is being dissolved
What does CRP (C-reactive protein) test for
- General marker of inflammation, acute or chronic
- Elevated >10 is usually positive
- Protein produced by the liver
What is the H&H rule of thumb
- Hemoglobin and hematocrit should be 10 & 30
- If lower use a sx based approach
What does hemoglobin assess and describe if trending up versus down
- Assess anemia, blood loss, bone marrow suppression
- Trending upwards: polycythemia
- Trending downwards: anemia
- Reference values: males -> 14-17; females -> 12-16
What does hematocrit assess for and describe if trending up versus down
- Assess blood loss and fluid balance
- Trending upwards: polycythemia
- Trending downwards: anemia
- Reference ranges: males -> 42-52%; females -> 37-47%
Lab values and normal ranges for liver function/hepatic panel
- Serum Albumin (half life 21 days): 3.5-5.2
- Serum pre-Albumin (half life 2 days): 19-39; causes if trending down include burns, malnutrition, & thyroid disease
- Serum Bilirubin: normal -> 0.3-1.0; critical range -> >12
Lab values and normal ranges for kidney function
- Blood urea nitrogen (BUN): 6-25; trending down = hepatic disease/malnutrition; trending up = high protein diet, renal failure, CHF
- Serum Creatine; males -> 0.7-1.3; females -> 0.4-1.1; trending down = age/low muscle mass; trending up = renal disease, muscular dystrophy, rhabdomyolysis, dehydration
Hepatic encephalopathy due to elevated NH3 (Ammonia/marker of kidney/liver function)) if untreated can progress to
- Confusion
- Disorientation
- Sleepiness
- Death
What is the normal range for Ammonia (NH3)
- 10-80
Describe normal and abnormal lab values for diabetes
- Glucose normal: 70-100; fasting (FPG) = 90-130
- Glucose trending: up = FPG >126 or 2hr glucose >200 (causes DM, sepsis); down = <70 (causes excess insulin, brain injury, pituitary deficiency, Addison’s disease)
- Hgb A1C normla: <5.7%; pre-DM = 5.7-6.4%; DM = >6.5% (poor glucose control)
Describe normal and abnormal thyroid lab values
- Thyroxine (T4) normal: 4.5-11.5
- Triiodothyronine (T3) normal: 80-200
- Thyroid stimulating hormone (TSH) normal: 0.3-3.0
- Increased TSH AND decreased T4 = thyroid disease
- Decreased TSH = pituitary disease
Presentation of high T3&T4
- Tremors
- Nervous
- Tachycardia
- High metabolism
Presentation of low T3&T4
- Slow
- Depressed
- Ataxia
How does Rhabdomyolysis present
- Test strong MMT but Quick Fatigue
- Appear “Well” but unable to Move w/o MAX assist
- Labs: Way High CK levels
- Elevated BUN as Kidney function declines
- “Brown Tea” colored urine
Illness script for Rhabdomyolysis
- No defined LABS
- Who gets it: trauma (crush injury), burns, ischemia, electrical, prolonged immobility (fall & unable to get back up)
- Rapid onset can lead to kidney damage: high myoglobin 1st 24hrs and high CK next 2-5 days
